Date: Monday, November 6, 2017
Session Type: ACR Poster Session B
Session Time: 9:00AM-11:00AM
Background/Purpose: Undifferentiated Arthritis (UA) is defined as an inflammatory oligo/poly arthritis that does not fulfil criteria for a definitive diagnosis.Delay in diagnosis and treatment leads to poor prognosis. The aim is to identify synovial biomarkers that may be useful to diagnose patients with early UA
Methods: Retrospective longitudinal study.Patients with UA followed in our Arthritis Unit,who underwent arthroscopy between 2000 and 2014.Synovial biopsy were stained by immunohistochemistry (IHQ) with the following antibodies:antiCD3 (T cells),antiCD20 (B cells),anti CD79 (preplasma cells), antiCD138(plasma cells),antiCD31(vessels),antiCD68(macrophages),antiCD15(neutrophils),antiCD117(mast cells),antihsp47(fibroblasts), and quantified by Digital Image Analysis (Olympus).The same antibodies were evaluated in RA and PsA control groups. A transcriptomic analysis was performed to study different pathways of inflammation; only the Type 1 Interferon pathway shown differences between RA and PsA, IHQ with MxA (one of the gene of Type 1 IFN signature) was performed.
Results: 54 UA and 78 controls were included.Table 1 shows the clinical, serological and demographic characteristics at time of synovial biopsy. Among patients with UA, 24 (44%) patients met criteria for RA and 30 (56%) for PsA during follow-up. Synovitis of patients with UA had higher macrophage(CD68+) density in total tissue(p=0.008) and sublining(SL)(p=0.012) than the control group.The UA that evolved to RA had a higher density of CD3 T lymphocytes than the control RA group(p=0.014).No differences were observed in cells of adaptive immunity(CD20 B lymphocytes,CD138 plasma cells),innate immunity(CD117 mast cells,CD15 neutrophils),vessels(CD31) between the 4 groups. The area(%) stained by anti-hsp47 (synovial fibroblasts) in SL was higher in the RA control group than in the PsA(p=0.003). The expression of MxA was increased in pre-RA Group compare to RA control (p=0.036) especially in patients with synovial lymphoidneogenesis
Conclusion: This is the first immunohistological study of synovitis in a significant group of patients with UA who developed AR or PsA during follow-up. Although there are some differences between the UA and control groups in the density of CD68+ macrophages and lymphocytes T CD3+, these do not appear to be useful for an early diagnosis of UA. On the other hand, unlike the results of some previous studies, we not found differences between the cellular infiltrate (adaptive immunity, innate immunity or vessels) in patients with RA and PsA. The Type 1 Interferon pathway could be a biomarker in patients with UA who develop RA, but a prospective study would be necessary to validate this results. The fact that some patients with UA were undergoing treatment prior to synovial biopsy and its retrospective character limit the results of this study.
Acknowledgements: Financed:“Fondo de Investigación Sanitaria” (PI14/00785. JDCañete) del Instituto de Salud Carlos III. (ISCIII).Co-financed by BECA FER-2015.Premis “Emili Letang”,Hospital Clínic.BECA MSD-Sociedad Catalana de Reumatología
To cite this abstract in AMA style:Cuervo A, Celis R, Ramírez J, Usategui A, Faré R, Hernández MV, Ruiz-Esquide V, Inciarte-Mundo J, Sanmarti R, Pablos JL, Cañete JD. Higher Expression of Type 1 Interferon in Synovitis of Patient with Undifferentiated Arthritis before They Met Rheumatoid Arthritis Criteria Compared to Established Rheumatoid Arthritis. a Retrospective Study with 14 Years of Follow-up [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/higher-expression-of-type-1-interferon-in-synovitis-of-patient-with-undifferentiated-arthritis-before-they-met-rheumatoid-arthritis-criteria-compared-to-established-rheumatoid-arthritis-a-retro/. Accessed January 19, 2021.
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